Newborn care practices and home-based postnatal newborn care programme – Mewat, Haryana, India, 2013

Abstract

Background:

In India, the Home-Based Postnatal Newborn Care (HBPNC) programme by Accredited Social Health Activists (ASHAs) under National Rural Health Mission was initiated in 2011 to reduce neonatal mortality rate (NMR).ASHAs get cash incentives for six postnatal home visits for newborn care. We studied newborn care practices among mothers in Mewat, Haryana having a high NMR  and  determined risk factors for unsafe practices and described the knowledge and skills of ASHAs during home visits.

Methods

A cross-sectional survey was conducted among mothers who had delivered a child during previous seven months using cluster sampling. We interviewed mothers and ASHAs in the selected subcentres using semi–structured questionnaires on  the six safe newborn care practices viz. safe breast feeding, keeping cord and eye clean, wrapping baby, kangaroo- care, delayed bathing and hand-washing.

Results

We interviewed 320 mothers, 61 ASHAs and observed 19 home visits. Overall, 60% mothers adopted less than three safe practices. Wrapping newborns(96%) and delayed bathing (64%) were better adopted  than cord care (49%), safe breast feeding (48%), hand washing (30%),  kangaroo care ,(20%) and eye care(9%). Besides illiteracy and religion, birth spacing ? two years (OR: 2.1, 95%CI 1.1-4.1) lack of antenatal care (OR: 2.3, 95% CI 1.3 -4.0), home delivery (OR: 1.3, 95% CI 0.8-2.1), no contact with ASHA (OR: 2.0, 95% CI 1.1-3.3) were risk factors for unsafe practices. Cultural beliefs and traditional birth attendants (TBA) influenced the change of mother’s practices. The lack of supervision by Auxiliary nurse midwives (ANM) and delayed referral transportation were the other challenges.

Conclusions

Knowledge–practice gaps existed among mothers counseled by ASHAs. Poor utilization of RCH services decreased opportunities for ASHA–mother dialogue on safe practices. Recommendations included training ANMs, training TBA as ASHAs, innovative communication strategies for ASHAs and improved referral system.

Key words: home- based, newborn, practices, Mewat, ASHA, counseled.